We are by no means the only ones debating this. In fact, it seems that this question is resonating with may others and fuelling a debate across the world around the validity of mental illness diagnosis. You can access some of this debate on twitter, my account is @powysmh.

Whilst I for one am very interested in the impact that asking this question may have, I also wish to raise the need for caution.

In our drive to ensure that people are asked "what has happened to you" within health services, do we need to make sure that we don't miss the question “is there anything physically/organically wrong with you”?

Psychotic symptoms (e.g. hallucinations, delusions, disturbed and confused thoughts), for instance, can be caused by illnesses, diseases and physical health conditions. On the NHS Choices website there is a page that lists the medical conditions that have been known to trigger psychotic episodes. These include Malaria, Syphilis, Azheimer's disease, Hypoglycaemia, Lupus, brain tumour and Lyme disease. But, this does not seem to be a complete list. I have also come across other organic causes that were not listed there. B12 Deficiency, Porphyria, Wilson’s Disease, cerebrovascular disease can be found elsewhere on their site citing psychosis as one of the symptoms of these conditions .

These organic/physical causes produce symptoms of psychosis for a number of reasons, for example abnormal enzyme production, brain damage, tumours, chemical element poisoning, abnormal hormone action, abnormal blood supply to the brain and vitamin deficiencies. There are physical investigations and tests that can be done to determine whether someone is suffering from these conditions.

When someone first seeks help, or finds “help” thrust upon them, for psychotic symptoms, what investigations will occur to determine whether there is a organic/physical/biological cause?

Diagnosed with syphillis

For adults, the Map Of Medicine Pathway based on National Institute for Health and Care Excellence (NICE) medical guidelines states that if someone presents to them with suspected schizophrenia, then doctors need to determine whether or not there are any physical/organic explanations for their symptoms. Worryingly, I think, the recently published (Jan 13) NICE guidelines for psychosis and schizophrenia in children and young people, does not seem to indicate that psychotic symptoms can have organic causes. I could not find anything in the guidance, the supporting care pathway or the information for the public that indicated that psychotic symptoms could have organic causes. I have to admit that I might be missing something, the guidance is very long, so I will be contacting NICE to ask.

Can psychotic symptoms be misdiagnosed as "mental illness" when they are actually caused by organic/physical conditions?

Unfortunately it seems the answer to this is yes. It is not difficult to find examples of misdiagnosis, where psychotic symptoms that have an organic/physical/medical explanation have led to people being given a mental illness diagnosis. There has also been scientific work that highlights where organic disease has been incorrectly diagnosed as mental illness (e.g. schizophrenia).

How often can psychotic symptoms be attributed to organic/physical/medical explanation?

I am not sure that we really have the information that would enable us to get to a definitive answer, I have found figures that range widely, from 5% through to 30%. So over to you. Can you help me answer these questions? Are they questions worth asking? Tell me what you think ...

Should mental health services be shaped by the question what happened to you rather than what’s wrong with you?

In
our drive to ensure that people are asked "what has happened to you"
within health services, do we need to make sure that we don't
miss the question “is there anything physically/organically wrong with
you”?

When someone
first seeks help, or finds “help” thrust upon them, for psychotic
symptoms, what investigations will occur to determine whether there is a
organic/physical/biological cause?

Can psychotic symptoms be misdiagnosed as "mental illness" when they are actually caused by organic/physical conditions?

How often can psychotic symptoms be attributed to organic/physical/medical explanations?

5 comments:

Good luck with the mission Laura. There is a decent novel 'Human Traces' by Sebastian Faulks, and within it, if memory serves me correctly, the issue is raised of understanding psychosomatic phenomena as being things existent in both mind and body - or being to do with the relationship of mind and body at any rate. This area seems a minefield, and the question of distinguishing between physically (or organically) derived psychoses and purely mental alterations is philosophically speaking, a huge task, but needless to say, a question with very important practical ramifications.Your question of 'what happened to you' would always be at the centre of interactions in any healthy society or culture- as would the broadening of the psy-sciences (psychology, psychiatry and so on) to look at interactions of powerful events on individual minds and collectively evolving consciousness. Whether we would be going down a dead end by looking for simpler correlations of overtly physical disease with mental state in trying to understand the vast mass of temporarily recurring detachments from 'reality' as anything other than a highly important micro-biological development of the senses with macro scale human historical implications, I do not know. Your point that sometimes that's what may cause psychoses is well taken.The question of what happened to you, or 'us' - I would argue - is without doubt a positive thing. The answers however, are usually cut short these days as the intrinsic value of human experience pales in significance to the mad scramble for material resource that we are sadly all part of in some way.I know this is not your point- but if deeply residual physical/mental/emotional/spitirual changes within people are put down as being due to a simple cause or external origin too often, net suffering will perhaps increase.

Thanks for sending me some luck. As always I really thank you for your thoughts on this, your comments always give me food for thought. I love the book Human Traces - by the way.

I am glad that you too think we need to keep up with pushing the question "what has happened to you". I agree with you point about incorrectly trying to put things down to simple causes and not bearing witness to what is really happening for people. I believe this will lead/has led to bad consequences, even if the actions are/have been well intentioned.

From where I'm standing you are asking all the right questions. Apparently food plays a very important role in our mental well being. A much bigger role than we'd realised. Here's a link to a great article about just that http://articles.mercola.com/sites/articles/archive/2013/09/19/bad-diet-bad-behavior.aspx?e_cid=20130919Z2_DNL_art_1&utm_source=dnl&utm_medium=email&utm_content=art1&utm_campaign=20130919Z2 Hope this helps.

Misdiagnosed bipolar: One girl's struggle to get the right treatment. "This is an autoimmune disease, and I'm so sorry it took me this long to see you." http://news.msn.com/in-depth/misdiagnosed-bipolar-one-girls-struggle-to-get-the-right-treatment#tscptmf